Organization
VIVA SMILE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR MOUKADDEM (MANAGING PARTNER)
(708) 971-3321
Entity
Organization
Contact information
Practice address
1504 N WESTERN AVE, CHICAGO, IL 60622-6614
(708) 971-3321
Mailing address
3939 W FULLERTON AVE, CHICAGO, IL 60647-2243
(708) 971-3321
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/09/2025
Last updated
05/09/2025
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